Hormonal therapy for prostate cancer

Hormonal therapy is often used to treat early and locally advanced prostate cancer. If you have low-risk early prostate cancer you do not usually need hormonal therapy.

Doctors often advise having hormonal therapy with radiotherapy (including brachytherapy for prostate cancer), to make your treatment more effective. You may have hormonal therapy before, during and after radiotherapy. It can be given:

• a few months before radiotherapy, to shrink the cancer (neo-adjuvant treatment)
• after radiotherapy, to reduce the chance of the cancer coming back (adjuvant treatment).

Your doctor will talk to you about how long you take hormonal therapy for. They will also explain the possible side effects.

For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:

• intermediate-risk you may have hormonal therapy for a few months after radiotherapy
• high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.

For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.

There are different types of hormonal therapy. Your doctor or nurse will explain the treatment that is most suitable for you.

The pituitary gland in the brain makes make a hormone called luteinising hormone (LH). This hormone tells the testicles to make testosterone.

LHRH agonists interfere with this action and stop the testicles making testosterone. You have them as an implant injection or an injection under the skin.

The commonly used LHRH agonists are:

• goserelin (Zoladex^®, Zoladex LA^®)
  You have goserelin as an injection of a small pellet (implant) under the skin of your tummy (abdomen). The drug is released slowly as the pellet dissolves. You have it every 4 weeks, or as a longer-acting injection every 12 weeks.
• leuprorelin and triptorelin (Decapeptyl^®, Gonapeptyl^®)
  You have leuprorelin and triptorelin as an injection under the skin or into a muscle. Leuprorelin can be given either once a month or every 3 months. Triptorelin can be given once a month, or every 3 months or 6 months.

A nurse or doctor at your GP practice or hospital can give you these drugs.

The first time you have one of these drugs, it can cause a temporary increase in testosterone. This can make any symptoms worse for a short time. This is sometimes called tumour flare. To prevent this, your doctor usually asks you to take an anti-androgen drug, such as bicalutamide (Casodex^®). You take it for a short time before and after starting the LHRH agonist.

These drugs stop testosterone from reaching the cancer cells. You take them as tablets.

You may have anti-androgen drugs with radiotherapy, instead of an LHRH agonist. Or you may have an anti-androgen before and after the first injection of a LHRH agonist. This is to prevent any symptoms getting temporarily worse (tumour flare).

Anti-androgen drugs for prostate cancer include:

• bicalutamide (Casodex^®)
• cyproterone acetate (Cprostat^®)
• flutamide.

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